About

About

A free, plain-language library of letters for appealing a denied health insurance claim — and getting it paid.

A denial notice rarely explains how to fight it. It states a reason and a code, references plan language you've never seen, and leaves you to guess at the deadline. Most people give up there. This site collects the letters that actually move a denial: the internal appeal, the ERISA request for the claim file the insurer used against you, the expedited route when treatment can't wait, the external/independent review, and appeals written for the specific reason you were denied — medical necessity, prior authorization, step therapy, experimental/investigational, out-of-network, drug formulary, timely filing, and coding errors.

Every letter is a starting template, written to be edited. Where a federal rule applies (for example the Affordable Care Act's internal-appeal and external-review rights, or ERISA's "full and fair review" claim-file disclosure), the guide names it and links the idea to the rule; where timeframes vary by plan type, it says to read your own denial letter. Nothing here is legal, medical, or insurance advice, and using a template creates no professional relationship.

For help specific to your claim, free resources exist: your state's Consumer Assistance Program or Department of Insurance, the nonprofit Patient Advocate Foundation, and Legal Aid. For complex, urgent, or high-dollar denials, talk to a licensed attorney or a professional patient advocate.